Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
MC-18-602
Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL , Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-298930 Permit Number: MC-3-18-602 Scheduled Inspection Date: March 15, 2018 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: yILLATE,JOHN Work Classification: A/C Replacement Job Address:100 NW 98 Street Miami Shores, FL 3 3150- Phone Number Parcel Number 1131010260080 Project: <NONE> i Contractor: STAR AIR CONDITIONING CORP Phone: (305)969-1090 Building Department Comments REPLACE A MINI-SPLIT UNIT , Infractio Passed Comments IN-OUT INSPECTOR COMMENTS False "! L � t8 Inspector Comments Passed Failed ' I Correction Needed 7 Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. + i i 4 March 14,2018 For Inspections please call: (305)762-4949 Page 25 of 43 Permit NO. MC-3-18-602 y� Miami Shores Village Permit Type:Mechanical-Residential 10050 N.E.2nd Avenue NW r I Work Classification:A1C Replacement Miami Shores,FL 33138-000Perill Permit Status:APPROVED Phone: (305)795-2204 F�bRi"oA 09108/2018 Issue Date:3/1212018 Expiration: Project Address Parcel Number Applicant 100 NW 98 Street 1131010260080 Miami Shores, FL 33150- Block: Lot: JOHN VILLATE Owner Information Address Phone Cell JOHN VILLATE 100 NW 98 Street MIAMI SHORES FL 33150-1739 PO BOX 191017 MIAMI BEACH FL 33119- Contractor(s) Phone Cell Phone Valuation: $, 1,775.00 STAR AIR CONDITIONING CORP (305)969-1090 �_._ .... ....,.. .,_.... ._w.._ ——..... ...,.,... Total Scl Feet: 0 Tons: Available Inspections: Additional Info:REPLACE A MINI-SPLIT UNIT, Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved: : In Review Date Denied: Type of Work:REPLACE A MINI-SPLIT UNIT, Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# MC-3-18-66721 DBPR Fee $2.00 03/12/2018 Check#:4345 $60.20 $50.00 DCA Fee $2.00 Education Surcharge $0.40 03/08/2018 Check#:4336 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $110.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-named contractor to do the work stated. March 12, 2018 Authorized Signa re: wner / Applicant / Contractor / Agent Date Building Department Copy March 12, 2018 1 Miami Shores Village 'I'V ED f �j Building Department MR O 18 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 y — Tel:(305)795-2204 Fax:(305)756-8972 ,-��• ___, . INSPECTION LINE PHONE NUMBER:(305)762-4949 F B C 2a�� e BUILDING Master Permit No. M Ci p ' (00 Z PERMIT APPLICATION Sub Permit No. ❑BUILDING .❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL f ❑PLUMBING ,MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP , ) q CONTRACTOR DRAWINGS JOB ADDRESS: I U O I City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type:�_Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 3-ci Y `Y-\ V I �R_ Phone#:3 1 g 5 ' Address- U W 9 0 �A ,rttom� City:—M, State: U^ Zip: Tenant/Lessee Name: Phone#: Email: c n (� CONTRACTOR:Company Name: S��Q ` C��V - Phone#.-3 (° (090 Address: Ugr-) Sw -�S-5 City: �� 1 rn State: �. Zip- 7� t Qualifier Name: �A nn �-S� V--'C-- Phone# State Certification or Registration#:1 , 13� f Certificate of Competency#:O 8 /11 (?Crj 1 �� DESIGNER:Architect/Engineer: 1 ' Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1 Square/LinearrFF9ootage of Work: Type of Work: ❑ Ad ition ❑ Alteration ❑nnNew L� Repai r/Replace ❑"Demolition Description of Work: C � " `on 1 - t 1 U ry ._F-c � Specify color of color thru tile: "A Submittal Fee$SoGt Permit Fee$ G 190 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE.$ V (Revised02/24/2014) k; Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) ; Mortgage Lender's Address City State" Zip Y Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be`secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant:.As a condition to the issuance of a building permit with an estimated volue'exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. \J A(� ! r Signature V Air o Signature I OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 'w1 Ya 2 C Y 20 by day of�i C 20 JZ , by who is personally known to I' S0.rC ho is ersonall known to N y � C� r Y epr who has produced as rr e&r who has produced as. identification and who did take an oath. identification and who did take an oath. N Y PUBLIC: N Y PUBLIC: \ r Sign: rr,, � Sign: Print: J n V �~� i Print: P"BiJUAN B.ORTIZ Seal: o�* , B�� JUAN B.ORTIZ * * MY COMMISSION f FF 138531 . ... Seal: EXPIRES:July 19,2018 * MY COMMISSION#FF 138531 * EXPIRES:July 19,2018 °'+rf of F7de Bonded TAru BuApet Notary Services °l+,F F`oti�e Bonded 1hro Budget Notary Services ##################################### #### ################################################################ APPROVED BY VIVS Examiner Zoning r Structural Review Clerk r (Revised02/24/2014) ,rt►�RFs y Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 0ON, Tel: (305)795.2204 loRtr�' Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets fy are not acceptable. Job Address(where the work is being done): ' 00 1 �/ q � Sl City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO E Contract Attached:YES ❑ b�5 '1� UNIT BEING REPLACED DATA NEW UNIT Q X\Y-o R(Z MANUFACTURER Co r•f a ?T S v, (L AHU or PKG. UNIT MODEL# COND.UNIT MODEL# KW HEAT NOM TONS AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / f PKG UNIT EER/SEER YES NO REPLACING DUCTS YES !IV YES NO REPLACING THERMOSTAT YES YES NO NEW 4"CONCRETE SLAB YES YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: G� Contractor's Company Name: S K C C G R P _ Phone: 3 I 6 C(0 State Certificate or Registration No. Certificate of Competency No. ' Signature Date: A b g (Qualifier's signature) i (Revised02/24/2014) ° n nRn CERTIFICATE OF LIABILITY INSURANCE DAT 03/02D/YYYY) 03/02/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Maritza Indan Eguino&Associates PHONE • (305)266-1700 ac No): (305)267-1197 7229 Coral Way E-MAIL Mindan@eguino.com t Miami,FL 33155 INSURERS AFFORDING COVERAGE NAIC# Phone (305)266-1700 Fax (305)267-1197 INSURER A: CYPRESS PROPERTY&CASUALTY INSURED INSURER B: ` STAR AIR CONDITIONING CORP. INSURER C: 12045 SW 185 Terr " INSURER D: t INSURER E: Miami,FL 33177- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UB POLICY EFF POLICY EXP LIMITS LTR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 GE TO O COMMERCIAL GENERAL LIABILITY PREM SES EaENTED occurrence $ 1009000.00 A F-1 F-1CLAIMS-MADEQ N N 09/12/2017 09/12/2018 OCCUR GFL-10026990881 MED EXP(Any one person $ 5,000.00 F-1 PERSONAL BADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000.00 D POLICY ❑ PRO- ❑ LOC 1 1 $ AUTOMOBILE LIABILITY (CEOeccc S dentINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL AUTOS OWNED ❑ AUTOS SCHEDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ F-1HIREDAUTOS [:1 AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE t $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATIONWC STATU- El OTH- AND EMPLOYERS'LIABILITY Y/N RY IMfr ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) a E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Service and Repair-AC System to be installed CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores,FI 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 _ 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 PLASENCIA, BELGRABE # STAR AIR CONDITIONING CORP 16600 NW 54 AVENUE#3 MIAMI FL 33014 Congratulations! With this license you become one of the nearly ,±--�___ �}__�_ • �_ one million Floridians licensed by the Department of Business and �^�-•-- Professional Regulation. Our professionals and businesses range .�STATE'OF FLORIDA:.------ from architects to yacht brokers,from boxers to barbeque DEPART,�I ;_BUSINSS:AND— restaurants, and they keep Florida's economy strong. PROFEI LGl'1LATION�� Every day we work to improve the way we do business in order RA130 4,29 tSSM1D x+08%1'0/2017 to serve you better. For information about our services, please- :- log'onto www.myfloridalicense.com. There you can find more `-REG'AIR;;GO TIQN1 C N�f A6fiOR - information about our divisions and the-regulations that.impact PLASEGVGI - L learn more about A. I' 4 w 4 you, subscribe to department newsletters and a S�fAR'AIR�CO�ITIDt� the Department's initiatives. (tNDIVID L tJS�I� ET AL LO L Lf ENSIIVG:RE�E E IT, I_EJ Our mission at the Department is: License Efficiently, Regulate ;p°�O FRACTIIVt�I"N 'AREA} Fairly.We constantly strive to serve you better so that you can ERE .trrrder.thpFovisio .48 FS. serve your customers. Thank you for doing business in Florida, ExviraG ca �u� .zo'is - ' ►naoe�,h.4 9-E and congratulations on your new license! ............. ...... DETACH HERE ... _ ...... _ RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY `Y r. -`"' -mow,�.` r'' ._ -.,."'_• _ STATE•OF FL`ORIDA*,�� --i. ✓..---DEP.ARTMENT OF-BUSINESS.AND PROFESSIONAL REGUL•ATION� r-^'�'�CONST.RUCTION'INDUSTRY;LICENSItVGB.OARD>.���\ �1 ' �RA13067429'"�_ _ ,,,..r..r--•.,.,� _ ` Ttie-CL-ASS-AAIB-CONDITIONING CONTRACTOR �� N'amed.beo-r-riAS;REGISTERED t�.�`• Under�the.prrovislons#of,3-1 ;Ghapter 489-FS. J frzpi ati5n date- AUG20'19 ...w. (INDIVIb.IJArMU EET-A-L'�OC/AL 61,GEN0 NG, IEQUIREMI�NTS•PRI'QR'TO'C®NTRACIG`IN.AIVY RMA) PLASE� NCGT_A;B.EL'GRAB I r -ARrAIR=CONDI I,ONIN' ;CORP 2�5-SW 185"7TERRA`Ct: ` - ti. •" MIAl�llt=� FL:'331 4 LN Y ISSUED: 08/10/2017 DISPLAY AS REQUIRED BY LAW SEQ# L1708100000680 x 4 The Department of Management Services'Office of Supplier Diversity"serves those who serve Florida." G��'7_supplier The Office of Supplier Diversity provides resources designed to improve business and economic opportunities for Florida's DIVERSITY woman-,veteran-and minority-owned businesses.Learn more about becoming a'certified business enterprise at dms.myflorida.conVosd or call 850-487-0915. k- FloNtlz To find out about State of Florida tools supporting statewide centralized procurement activities whichhave streamlined �_�� interactions between vendors and state government entities,please contact or visit the Department of Management Services' T; Q MyFloridaMarketPlace at:haps✓/vendor.mgfloridamarkgtvlace.com t _ AC# 01900415 } SIGNATURE 1 r { (For the protection of our professional license holders,this licence contains hidden securityf atm ,nterfeiting Unauthorized reproduction is strictly prohibited and will be prosecuted to the fullest extent of the law) The Department of Business and Professional Regulation(DBPR),issues licenses for many'licensed businesses and practitioners in the State of Florida.. DBPR is changing the way you interact with state government.Many of DBPR's services are available online at www.MyFloridaLicense.com. We encourage you to utilize these services to make address changes,licensing changes or to renew your license. Name changes require legal documentation verifying the name change,which must be mailed to the DBPR.An original,a certified copy or a duplicate copy of an original or certified copy of a document that shows the legal name change will be accepted,unless the DBPR has a question about the authenticity of the document. If applicable,the DBPR will send a renewal notice to your last known address or email address of record._If you have not received your renewal notice,please call our Customer Contact Center at 850.487.1395 or online at www.MyFloridaLicense.com/contactus. i Please refer to your profession's governing statutes and Administrative codes for further information regarding renewals.These may be accessed from our website. { AC# 01900415 t QUALIF`(ING-'-TRADE(S) 0003 A/C-UNL fO INW- Jaime D.Gascon.P.E. Seatta d.je CaxY�re sY PAYS keret°. E i i { 4 4 { 4 P Cirqualifying Board Construction Tra BUSINESS CERTIFICATE OF COMPETENCY a 08M000722 STAR AIR CONDITIONING CORP 1 _ D.B.A.: PLA/SENCI EGRABE ovisions of O er 10 of Www i-Dade CaardY is certified under the pr Municipal Contractor's Tax Recei pt M lam I-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY CC NO: 08M000722 MC BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES STAR AIR CONDITIONING CORP 12045 SUV 185TH TER 7528910 SEPTEMBER 30, 2018 MIAMI,FL 33177 Pursuant to County Code See 10-24 OWNER TYPE OF BUSINESS PAYMENT RECEIVED STAR AIR CONDITIONING CORP SP13,MECHANICALCONTRACTOR BY TAX COLLECTOR 37.50 03/08/2018 0224-18-003007 , Restricted to City of Miami Shores MI®� For more information,visit www.mi arridada goy/taxcoll actor i 003957 i Local Business Tax Receipt - Miarni-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY z 6316517 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES STAR AIR.CONDITIONING CORP RENEWAL /� SEPTEMBER 30, 2018 12045 SW-185 TERR 6582945 Must be displayed at place of business MIAMI FU33177 Pursuant to County Code J' Chapter 8A-Art.9&10 M OWNER _ SEC_TYPE OF BUSINESS STAR AIR CONDITIONING CORP 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED __. . 08M000722 $75'00. 07 26.201�r-,- BY AX COLLECTOR W _ orker(s) _ 4 ECHECK-17-188136 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental' or nongovernmental regulatory laws and requirements which apply to the business. I The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276. For more information,visit www.miamidede.goy/texcollector 1 i PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE + I STATEOFFLGRIDA - - - - - - - - - - - - - - - - -- - - - - - - -— — — — — —— — — — — — — — — � I °Dnnsallo WORK RS'COlMulPENSA EON I IMPORTANT I CONSTRUCTION INDUSTRY EXEMPTION I F Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDAI O who elects exemption from this chapter by filing a certificate of WORKERS'COMPENSATION LAW •��D vn I L election under this section may not recover benefits or compensation under this chapter. I EFFECTIVE DATE: 7111/2017 EXPIRATION DATE: 7/11/2019 D Pursuant to Chapter 440.05(12),F.S.,Certificates of election t0 i PERSON: ORTIZ JUAN B I be exempt..apply only within the scope Of the business or trade I H listed on the notice of election to be exempt. FEIN: 282520009 I I BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13),F.S.,Notices of election to be I exempt and certificates of election to be exempt shall be I STAR AIR CONDITIONING,CORP. R subject to revocation if,at any time after the filing of the notice) E or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this 12045 SWISS TERR I section for issuance of a certificate.The department shall revoke I a certificate at any time for failure of the person named on the MIAMI FL 33177 certificate to meet the requirements of this section. I I SCOPE of BUSINESS OR TRADE: I I H.WN.V.aewun,Mr. I i Syw " - I I— MO R=r,Snob,Yard8 — — — ———II—— — — — — — — — —— — —— —— — — ——— —————— —— ————i Oman t DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 + t I 1 1 ' + A (